• Rayner Morrison: working as a health trainer with the Gypsy and Traveller Community in Barnsley

Rayner has travelled and lived all over Europe but considers Barnsley, where she was born and her mother before her, to be home. She lives there now, in a caravan on land belonging to her father, together with her brothers and their wives and children. Rayner didn’t attend school after the age of eight but she is fairly unusual in her community because she can read and write, she is also unusual amongst the young women because she has a paid job as a health trainer.

Rayner first heard about health trainers just over 2 years ago when she was 18 years old and her father had a ‘men’s MOT’ offered by the Primary Care Trust. She met Ann, a public health manager at the PCT and with her encouragement and that of Sharon who manages Barnsley Black and Minority Ethnic Initiative (BBEMI) she applied for and got a job with the newly established health trainer service.

Rayner undertook a training programme to qualify as a health trainer and now works with BBEMI who are commissioned by the PCT to provide the service to the local gypsy and traveller community. Her job is very varied – she helps organise events and activities with and for the community for example a women’s health event which combines discussion of mental health issues with a pampering session. She tells people about services and encourages them to access them where needed. This can include accompanying people to attend (illiteracy is a major barrier – people are fearful of having to fill in forms etc).

Many gypsies and travellers are not registered with a GP, so have found the newly opened Walk In GP Centre in Barnsley of great value as they don’t need to be registered or to make an appointment. Rayner also gives one to one support to people who want to make a lifestyle change, but more often she finds herself supporting them to register with a GP, sort out rubbish collection or proper toilet facilities rather than to stop smoking or take more exercise. However she has helped one young woman to train as a walk leader and to set up a walking group and persuaded some of the men to go for health MOTs. Many of the women have supported each other to eat more healthily and lose weight.

Rayner is helping some of the younger people who are literate to apply for places at college. One particular client was a woman in her thirties who was drinking very heavily. Her partner had died and she had no children so she felt very isolated, and other community members saw her as an embarrassment. With a lot of support from Rayner and some other community members she went into rehab for 2 weeks and has now stopped drinking completely and is getting involved in community activities.

Another member of the community, Joanne, has now also trained as a health trainer and is working with Rayner, again doing many and varied things to support the community and connect people into services. This is not always easy as people move around and services can be rigid in the way they work.

The biggest issues for gypsies and travellers remain social and economic – getting planning permission for sites, finding somewhere to stay, getting moved on plus the recession is making it harder for many of the men to find work. Stress and mental health issues are therefore a big issue.

In the future Rayner would like a full- time job and perhaps to move into community development work, but to still be supporting her community in Barnsley.

The Gypsy and Traveller community in Barnsley

There are lots of different gypsies and travellers. The community in Barnsley are English Gypsies and Travellers, although of Romany origin, with roots going back to India. Rayner describes her community as ‘well knit, very family orientated and old fashioned’. She says that they are generally ‘distrustful and suspicious of ‘the authorities’. The men are nearly all self employed doing jobs like gardening and landscaping. The women marry young, and then care for children and look after the home. They rarely work, and if they do it’s in poorly paid jobs like cleaning. Young people stay living with their parents until they marry.

Nationally we know that:

  • Gypsies and Travellers are five times more likely to experience ill health that the general population.
  • They have a life expectancy 10-12 years less than the settled population
  • Gypsy and Traveller women are five times more likely to experience the loss of a child

In addition the community is characterised by:

  • High rates of smoking
  • High rates of obesity
  • High numbers with long term ill health
  • High numbers caring for dependents
  • Less take up of preventative health care
  • Low levels of fruit and vegetables eaten
  • High levels of stress and mental health problems.

Health Trainers in Barnsley

  • £336k of mainstream PCT funding has been secured to deliver the health trainer service
  • The PCT commissions the service from 5 different voluntary and community organisations (VCOs) one of which is BBEMI.
  • There are 16 health trainers in total – 14 of them are based in 4 deprived parts of the district and 2 with gypsies and travellers.
  • 3 – 4 health trainers work as part of a small community development (CD) team, and are managed by the CD worker in each locality, plus 2 work with BBEMI.
  • Most of the health trainers started out as volunteers (eg community parents)
  • The health trainers do a lot of outreach, much as part of activities organised by the CD team.
  • The health trainers are trained to take blood pressure which is a popular activity and helps them make contact with people at events – many of whom then go to see them one to one.
  • They aim to see clients for 6 sessions but are flexible according to need.
  • Health trainers see clients in their homes or in a variety of accessible bases.
  • They work with clients on whatever issue is a priority to them and can accompany clients to services/activities where needed
  • A big part of their role is to reconnect clients who have lost trust in professionals, into services such as dentists and GPs, and to signpost to other services (eg for food boxes when giros don’t arrive)
  • Health trainers have negotiated free entry to the local leisure centre where they are accompanying a client.
  • If several clients are expressing a need for an activity or service, this is referred to the CD team who, if there is sufficient interest, will work with local people to set up local activities in response to need.
  • Health trainers work closely with the Stop Smoking Service (SSS), doing home visits for clients unlikely to make it to the SSS in town – 39% of the primary issues which clients in Barnsley decide to work on are smoking.

Building the evidence base: the Data Collection Reporting System

The Data Collection Reporting System (DCRS) is a national system funded by the Department of Health (DH) which is used by the majority of health trainer services and enables information about health trainer activity to be collected and reported on at district, regional and national levels. All services using the system have to enter data relating to 4 key outcomes identified by DH and known as the minimum data set. These are:

  1. Increasing capacity and capability through building the workforce with the skills in place to tackle health inequalities
  2. Reaching the hard to reach
  3. Delivering sustained improvement to the health of the people of England through behavioural change
  4. Providing access to and encouraging the appropriate use and take-up of NHS and other services

In Barnsley health trainers collect information from clients in paper form and enter it into the electronic DCRS when they return to their office base. The system enables managers to identify ‘at the push of button’ whether they are successfully targeting the clients they want to (postcodes and ‘community of interest’ is recorded), what issues clients are working on and what progress they have made.

In many ways the work of Rayner and Joanne with the gypsy and traveller community in Barnsley has a different emphasis from that of other health trainers. Because of the needs of their community they often focus more on helping around the broader social and economic factors that impact on health, rather than supporting people to change their lifestyle. Rayner says that filling in the DCRS forms can be a challenge – there is nowhere to record ‘help to get proper toilet facilities’!!

  • This case study has been written up by Judy White, Regional Health Trainer Lead for Yorkshire and Humber and is based on an interview with Rayner Morrison, Health Trainer and draws on information about the Health Trainer Service provided by Ann Toy, Public Health Manager with Barnsley PCT.

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